“Mid Staffs is not a one-off. As this paper reports today, an additional 3,000 patients are believed to have died needlessly in five other trusts in Lancashire, Essex and Greater Manchester... And what has been the response to this institutionalised carnage? Or more specifically, the response from the radical left, the self appointed guardians of the National Health Service? Nothing but deflection or silence.”

It’s an important point. To be a credible party of One Nation, Labour must be willing to criticise the public sector where it fails. In the same way, Conservatives must be prepared to attack flaws in the private sector. If we don't, we are simply a pressure group for vested interests.

But nowhere is the silence on Mid Staffs more deafening, than the total, blank, enourmous, disappointing silence on the website 38Degrees.org

As ConservativeHome readers will know, 38Degrees made its name - and hoovered up more than one million online members - by campaigning to stop Andrew Lansley’s NHS bill. “Save the NHS!” They cried, “Publish the risk register!” And so on. Anyone who worked in Parliament during that time will remember it. Millions of machine-emails were sent; postcards posted; surgeries attended; rallies and demonstrations held.

The Daily Mirror even put a tombstone on its front cover, with the words: “NHS, 1948-2012: KILLED BY THE COALITION”. I remember walking to work at 8am, on a cold weekday, and a demonstrator (who for some reason did not have to be working) saw that I was going into Parliament, and shouted at me: “Scum destroying our NHS!” Given that two members of my close family have worked on the NHS frontline, this seemed a little aggressive. But tensions were running high.

Now that the Mid Staffs report has been published and debated in Parliament, it makes difficult and upsetting reading - wherever you fall on the political spectrum. Thousands died. The truth was covered up. Problems were endemic and not just because of a few rogue individuals. But, where is the 38Degrees campaign for NHS reform? Where is the e-petition on their website, saying, “24 hours to save the NHS”? In the past, they have moved quickly to jump on a topical news agenda. So why not now, on their central issue of defending the National Health Service?

38Degrees will have no credibility on NHS reform in the future, if they don't step up to the plate now. I’ve met the CEO of 38Degrees - David Babbs - a few times, and like him. He’s a nice guy, and seems sincere in his intentions. He has told me more than once that he’s not a front for the Labour Party, and I believe him.

The headline figures on Anthony Wells’ blog, UKPollingReport, make for grim reading but are not a catastrophe. Conservative support rallied a touch before Christmas, before slouching back into our expected mid-term slump. But there are grounds for optimism. With the right emphasis, we could rally again.

My fear about House of Lords reform - with a referendum, or without one - is how massively, exhaustively, mind-bendingly dull it is to most people who are not hardcore political obsessives. Reforming the upper chamber is important. It is controversial. It may even be right. But it is unbelievably boring. We may as well campaign on algebraic fractions, Rubix Cubes, or getting the highest score on the Microsoft pinball game.

Imagine the exchanges on the doorstep. “Hello, we’re from the Conservatives! We’re fighting for House of Lords reform!” Answer: “Er...” The 2010 general election was fought tooth and nail on saving Britain from debt, taxes, and a lost decade of growth. In a globalised marketplace, the next election will be fought on the same lines. And the next one after that. And so on, and so on, to infinity. It is already hard enough to enthuse people - we shouldn’t deliberately send them to sleep.

That’s why if we’re itching for a referendum, the best option might be to adopt Tim Montgomerie's plan of an In/Out vote on Europe, timed to coincide with the next General Election. The arguments in favour of House of Lords reform are really at heart about the “democratic deficit” of appointed Peers. Fair enough, but surely, the biggest democratic deficit that we face is the whopping great one in Brussels? More importantly - it is the lack of any direct accountability in European institutions, not in the House of Lords, that truly incenses many voters in the Conservative family.